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How diversity and inclusion continues to be incorporated in dermatology

*This article has been developed and funded by Janssen-Cilag Ltd

Healthcare is an area where diversity and inclusion (D&I) can directly affect a person’s quality of life and treatment outcomes. Recently in the field of dermatology, a focus on D&I is helping to redress historical bias and open avenues of research, bringing benefits to patients and healthcare systems alike.

Historically, medical textbooks have described skin symptoms in Caucasian-dominated language, based on lighter skin tones – causing diagnosis and treatment disparities, with patients with darker skin tones being under-diagnosed and under-treated.1 Today, medical education programmes are rewriting textbooks, materials, and trainings to bridge this knowledge gap and reduce the chances of skin colour impacting accurate diagnosis and treatment. The British Association of Dermatologists highlighted the issue, noting that descriptors for rashes and lesions have been based on people of European ancestry.2 It observed that it is “vital that the language used for describing rashes/lesions in dermatology is updated, to be inclusive and reflective of the UK’s ethnic diversity.” Demand is clear: a new clinical handbook of signs and symptoms in black and brown skin called Mind the Gap, has been viewed online more than 100,000 times.3

Janssen, as part of the pharmaceutical companies of Johnson & Johnson, has a 130-year heritage in healthcare. As we rise to the call to help address historical inequities, we are proud to take a multi-faceted approach which includes the active embedding of D&I principles throughout our organisation. In immunology, we’re reframing clinical trials, drug development, and support networks for patients suffering with chronic skin conditions and other diseases. D&I must be integral to beliefs and behaviours to be truly transformative in healthcare.

Dr Mehbub Shafi, Medical Advisor at Janssen-Cilag Ltd, notes changes seen since his medical training: “Dermatological conditions affect patients of all skin tones, but symptoms can manifest differently,” he says. “While lack of awareness of these differences may have been an issue in the past, I can see that things are improving.”

A clear example can be seen in psoriasis, an incurable chronic condition affecting 1.8 million people in the UK, 14 million Europe-wide and 125 million globally.4,5,6 The effects can be both physically and psychologically scarring. Research has shown that 37% of psoriasis patients experienced suicidal thoughts, while the impact on family members is evidenced by 37% of close relatives and partners reporting their relationships suffered because of the condition.7,8 Every aspect of life is impacted – for example, people with psoriasis miss an average of 306 hours of work per year, more than eight weeks based on a 7.5-hour work day.9

Dr Shafi notes: “There is the medical aspect, which is huge, but the psychological and psycho-social aspects are important too because patients living with a dermatological disease often have a higher incidence of mental health issues. Addressing diversity and inclusivity to achieve optimal treatment is pivotal in improving outcomes for patients with darker skin tones.”

Diversity is relevant not just in psoriasis diagnosis, but also in treatment where, for example, higher doses of phototherapy may be needed for darker skin.10 Janssen’s UK medical education programme, aimed at and targeted to dermatologists across the UK, has focussed specifically on diversity and skin of colour. Janssen is also actively working with the UK dermatological community to develop resources supporting diagnosis and treatment in diverse communities, through partnerships with patient advocacy groups and patient advisors to ensure materials are tailored to diverse patient needs.

When it comes to decision-making in dermatological R&D, Janssen works with patients to enshrine the patient voice. “This helps us deliver on the Johnson & Johnson credo: our first responsibility is to patients, doctors and nurses, followed by our responsibility to the communities in which we live and work, and then the global community,” says Dr Shafi.

“In addition to supporting better access to care, we are also raising awareness in the healthcare community about important issues in the diagnosis and treatment of diverse or under-represented groups. It is important to gain feedback from patients living with psoriasis and healthcare professionals, understanding their concerns and then implementing and driving activities that will have an impact.”

At Janssen, the patient voice is central to pursuing novel research and improving therapies, to support work to stop and even cure dermatological diseases. Janssen will continue working with patients and experts to promote health equity for all as we work towards our mission to redefine treatments for dermatological diseases by delivering transformational and accessible therapies.

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1 Takeshita J, Gelfand JM, Li P, et al. Psoriasis in the US Medicare Population: Prevalence, Treatment, and Factors Associated with Biologic Use. J Invest Dermatol 2015; 135(12): p2955-2963

2 British Association of Dermatologists. Improving Descriptors in Dermatology. Available at: Last accessed: September 2022

3 Dhillon R, Booth AJ & Mukwende M. Mind the Gap. British Dental Journal 2021; 230(273)

4 Psoriasis Association. About Psoriasis. Available at: Last accessed: September 2022.

5 Augustin M, Alvaro-Gracia JM, et al. A framework for improving the quality of care for people with psoriasis. Psoriasis White Paper. JEADV 2012; 26(4): p1-16

6 National Psoriasis Foundation. Psoriasis Statistics. Available at: Last accessed: September 2022

7 Pompili M, Innamorati M, et al. Suicide risk and psychiatric comorbidity in patients with psoriasis. Journal of International Medical Research 2016; 44(1): p61–66.

8 Eghlileb A, Davies E and Finlay A. Psoriasis has a major secondary impact on the lives of family members and partners. British Journal of Dermatology 2007; 156(6): p1245–50.

9 Mustonen A, et al. How much of the productivity losses among psoriasis patients are due to psoriasis. BMC Health Services Research 2015; 15(87)

10 National Psoriasis Foundation. Psoriasis and skin of color. 2021. Available at: Last accessed: September 2022

Dr Mehbub Ali Shafi is Medical Adviser, Dermatology, The Janssen Pharmaceutical Companies of Janssen-Cilag Ltd.

* EM-80125 | September 2022

27th September 2022


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